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"(b) Severe acute respiratory syndromes, which are diseases that are associated with fever and signs and symptoms of pneumonia or other respiratory illness, are capable of being transmitted from person to person, and that either are causing, or have the potential to cause, a pandemic, or, upon infection, are highly likely to cause mortality or serious morbidity if not properly controlled. This subsection does not apply to influenza."
The anticipated eradication of poliovirus emphasizes the need to identify other enteroviral causes of severe central nervous system disease. Enterovirus 68 has been implicated only in cases of respiratory illness. We therefore report a case of fatal meningomyeloencephalitis caused by enterovirus 68 in a 5-year-old boy, which required neuropathology, microbiology, and molecular techniques to diagnose.
REPORT OF A CASE
The patient was a previously healthy 5-year-old boy with up-to-date immunizations who initially sought care for headache, low-grade fever, sore throat, and unilateral neck tenderness in the fall of 2008. He had no tick exposure or travel outside of New Hampshire. A number of classmates reportedly had coldlike illnesses. During the following 2 days, he experienced myalgia and progressive weakness of his arms (right arm to a greater extent than left) and a change in the timbre of his voice. Four days after onset he visited his primary care provider who believed he had a nonspecific viral illness.
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In the next few hours the patient developed bowel and bladder incontinence and the inability to walk. Later that evening he was found in bed, apneic and unresponsive, with intermittent tonic posturing of the upper extremities. He had a cardiac arrest en route to the hospital,...
Identification and sequencing of enterovirus 68 in the spinal fluid, combined with the characteristic histopathologic pattern of enteroviral central nervous system infection, established this virus as the cause of the fatal illness.3
Enterovirus 68 appears to be a rare cause of neurologic disease. The CDC Picornavirus Laboratory has identified only 1 other enterovirus 68 from CSF in the past 10 years. Nevertheless, identification of enterovirus 68 and other novel enterovirus neuropathogens will increase our awareness of their clinical role and pathogenesis and help establish their true incidence.
Smuggling is a major industry. Last year, Mexican authorities in Chiapas discovered two tractor-trailers carrying a total of 500 Central Americans, Indians and Chinese who had just crossed the Guatemalan border. Smuggling fees for immigrants from Asia and Africa depend on factors such as the length and risk of the trip and use of fraudulent documents. Chinese migrants pay as much as $65,000 and Indians about $25,000, according to U.S. border enforcement officials. If they cannot afford to pay upfront, clients borrow from family and associates or work off debts through indentured labor upon arrival in the United States.
In Latin America as in other regions, HRVs and HEVs account for a substantial proportion of respiratory viruses identified in young people with ILI, a finding that provides additional support for the development of pharmaceuticals and vaccines targeting these pathogens.
Acute respiratory infections (ARIs) are a leading cause of acute illness worldwide and remain the most important cause of pediatric mortality [1]. Lower respiratory tract infections (LRTIs) are among the leading causes of hospitalization and death in children less than 5 years old worldwide, particularly in resource-poor countries [2].
In this study, we investigated the recent circulation of HRV and HEV with emphasis on recombinant strains in children and young adults in Latin America.
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Overall, HRVs and HEVs were identified in 16% (548 samples) and 3% (84 samples) of the ILI cases, respectively.
The frequency of HRV identified in our subjects with ILI is similar or greater to what has been found for influenza virus [30,31], human metapneumovirus [32,33], respiratory syncytial virus [30,31], and adenovirus [31,34] in the region, emphasizing the potential clinical and public health importance of this virus.